# Contraceptives in chronic lymphocytic leukemia (CLL): a narrative review

## TL;DR

This paper reviews the challenges and considerations for contraception in women with chronic lymphocytic leukemia, especially those of reproductive age.

## Contribution

It provides a narrative review focusing on contraceptive counseling in the context of modern CLL treatments and oncofertility.

## Key findings

- CLL treatments like BTK and BCL2 inhibitors can affect fertility and require careful contraceptive planning.
- Contraceptive counseling should be integrated into multidisciplinary oncofertility care for women with CLL.
- Only 9% of CLL patients are diagnosed before age 45, but those of reproductive age need tailored approaches.

## Abstract

Women with chronic lymphocytic leukemia (CLL) face unique challenges when it comes to contraception. CLL predominantly affects older adults, with an age-adjusted incidence of approximately 4.7 new cases per 100,000 people per year and a median age at diagnosis of 70 years (Hallek and Al-Sawaf Am J Hematol 96(12):1679–1705, 2021). Although only about 9% of patients are diagnosed before age of 45, those who are of reproductive potential must carefully balance cancer treatment, fertility preservation, and effective contraception. In contemporary practice, most patients are treated with continuous Bruton’s tyrosine kinase (BTK) inhibitors or fixed-duration BCL2 inhibitor–based regimens, while chemoimmunotherapy is reserved for selected cases. These targeted approaches have variable profiles of cytopenias, bleeding and drug–drug interactions and can compromise ovarian reserve and carry teratogenic risks. This necessitates the need for tailored contraceptive counseling within a multidisciplinary oncofertility framework (Oktay et al J Clin Oncol 36(19):1994–2001, 2018).